Constipation Flashcards
What is considered constipation
Less then 3 bowel movements/week that are hard, lumpy, or difficult to pass
Causes of constipation
Narcotics
Dehydration
Colon cancer
Elderly
Travel
Complications of constipation
Hard stools, rectal bleeding, hemorrhoids
Etiology of constipation
“Not a normal part of aging”
Normal is different for everyone
Majority of cases are harmless
What conditions do we need to be cautious with for constipation?
Medication-induced constipation
Diabetes
Colon cancer
IBS
When to refer for constipation
Longer than 3 days w/o bowel movement
OR 1 week with at-home treatment
Red flags in constipation
Changes in stool textures
Blood in stool
Hemorrhoids
Weight loss
Decreased appetite
N+V
Frequent pain
Narrower stools
Unresponsive to treatment
Causes of large bowel obstruction
Cancer or large stool
Symptoms of large bowel obstruction
Belly cramping and pain
Belly swelling and bloating
Unable to pass gas and stool
Vomiting
More then what is seen in constipation and IBS-C
Non drug treatments for constipation
Fluid
Fibre
Exercise
How much fluid should someone with constipation have?
Men - 2L
Women - 1.6L
How much fibre should someone with constipation have?
For 19-30yo
Men - 34g
Women - 28g
What kind of fibre is best?
Insoluble
What is a natural laxative?
Prunes
What do prunes contain that is useful for constipation?
Insoluble and soluble fibre
Also contain sorbitol - most value here
What are the agents of choice for prevention of constipation?
Bulk-forming agents
MOA of bulk forming agents
Swells in intestinal fluid -> creates gel -> facilitates passage
Takes a few days to work
Needs intake of fluid
What is a one of the bulk-forming agents?
Psyllium (Metamucil)
MOA of psyllium (Metamucil)
Increases fecal mass within 48-72 hours
How often do you take psyllium?
TID
Side effects of psyllium
Psyllium induced obstruction if patient cannot drink much fluid
- Pain, cramps, nausea, no fecal output
When is stool softener useful?
For prevention
Common on maternity wards and with palliative care
Efficacy of stool softener
LESS effective than bulk-forming agents
What is drug in stool softener?
Docusate (colace)
Dosing for docusate
1-2 caps/day
4 caps/day for nursing homes
Up to 8 in palliative care
How long does docusate take to work?
1-2 days
When is docusate contraindicated
With mineral oil
What is used as a lubricant for constipation?
Mineral oil
MOA of mineral oil
Softens fecal matter by coating it
Side effect of mineral oil
Anal seepage
Lipid pneumonia when laying down -> avoid HS
What are the mineral oil products?
Fleet MO enema - works extremely quick
Agarol
Magnolax
Lanosyl - yummy jelly
When is saline(osmotic) useful for constipation?
For bowel evac exams (works within hours)
For bowel evac for acute constipation (Fleet)(works within minutes
General use - overnight relief (Philips)
MOA of saline
Put non-absorbable ions into gut drawing water into the gut
Efficacy of saline
NOT useful for seniors due to NO systemic effect
What is non-saline osmotic?
Glycerin suppositories
Lactulose syrup
PEG 3350
Who are glycerin suppositories the agent of choice for?
Infants and kids
MOA of glycerin suppositories
Osmotic effect and local irritant effect
Bowel evac within 30 minutes
Side effects of Lactulose syrup
Bloating and gas
What is the DOC for prevention therapy?
PEG 3350
What does label use say for PEG 3350?
Use <7 days unless MD
NOT for kids <18yo unless MD
What are the stimulants (rescue agents)?
Senna (senokot)
Exlax
Dulcolax
When are stimulants useful?
Use if NO BM for 3 days when also using preventative agents
For overnight relief
MOA of stimulants
Irritants/stimulates Ca2+ channels
To stimulate pulsing in the gut
How fast to stimulants work?
Within 6-12 hours
Side effects of stimulants
Bisacodyl and senna are minimally absorbed
Diarrhea/cramps
What are the herbal products?
Senna, psyllium, bran, aloe, rhubarb
What is probiotics use in constipation?
Helps with proper digestion and regularity
Prevention ambulatory care
Dietary efforts»_space; medications
Exercise / fluid intake / prune juice
Bulk forming agents / docusate / PEG 3350 / Lactulose
Acute treatment for ambulatory care
Senna
Bisacodyl
MoM
Red flags in ambulatory care
Unexplained new onset / worsening
Blood in stools
Weight loss
Anorexia
Fever
N+V
Family history of colorectal cancer
Prevention in long-term care
Lactulose vs PEG 3350
Docusate
Bulking agents
Acute treatment for long-term care
Fleet or micro lax or suppository
What is normal BM for infants
1 BM per each feed to 1 per week
Breast fed ~3/day and formula ~2/day
Cause of constipation in infants
Starting solid foods
Not getting enough fluids
Causes of contraption in children
Too busy to poop
Dietary
Toilet training issues
What % of women experience constipation during pregnancy?
50%
Is iron a major cause of constipation in pregnancy?
No
Treatment for pregnancy
Docusate - VERY COMMON
PEG 3350 - well tolerated
Psyllium - well tolerated but just a little less
What should NOT be used for treatment in pregnancy?
Senna/bisacodyl - uterine contraction concern
MoM = category B
Why do diabetics have less BMs?
Nerves are damaged
Treatment options for palliative care
Stool softeners - good for prevention
Osmotic laxatives - first line therapy
Stimulant - commonly used
Bulk forming - not recommended
Treatment for drug-induced constipation
D/c as many worrisome agents as possible
Add fibre
Add MoM or PEG 3350
Rescue agent
